Healthcare Provider Details

I. General information

NPI: 1437986429
Provider Name (Legal Business Name): KIOMI NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9001 WOODYARD RD STE C
CLINTON MD
20735-4264
US

IV. Provider business mailing address

2438 SANDWICH CT
CROFTON MD
21114-1681
US

V. Phone/Fax

Practice location:
  • Phone: 301-868-7333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR225250
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: